Healthcare costs in the United States account for a significant share of the GNP. The affordability of healthcare is of great concern to many Americans. Technological innovations offer an important leverage to reduce healthcare costs.
Many Healthcare institutions require doctors to keep accurate and detailed records concerning diagnosis and treatment of patients. Motivation for keeping such records include government regulations (such as Medicare and Medicaid regulations), desire for the best outcome for the patient, and mitigation of liability. The records include patient notes that reflect information that a doctor or other person adds to a patient record after a given diagnosis, patient interaction, lab test or the like.
Record keeping can be a time-consuming task, and the physician's time is valuable. The time required for a physician to hand-write or type patient notes can represent a significant expense. Verbal dictation of patient notes offers significant timesavings to physicians, and is becoming increasingly prevalent in modern healthcare organizations.
Over time, a significant industry has evolved around the transcription of medical dictation. Several companies produce special-purpose voice mailbox systems for storing medical dictation. These centralized systems hold voice mailboxes for a large number of physicians, each of whom can access a voice mailbox by dialing a phone number and putting in his or her identification code. These dictation voice mailbox systems are typically purchased or shared by healthcare institutions. Prices can be over $100,000 per voice mailbox system. Even at these prices, these centralized systems save healthcare institutions vast sums of money over the cost of maintaining records in a more distributed fashion.
Using today's voice mailbox medical dictation systems, when a doctor completes an interaction with a patient, the doctor calls a dictation voice mailbox, and dictates the records of the interaction with the patient. The voice mailbox is later accessed by a medical transcriptionist who listens to the audio and transcribes the audio into a text record. The playback of the audio data from the voice mailbox may be controlled by the transcriptionist through a set of foot pedals that mimic the action of the “forward”, “play”, and “rewind” buttons on a tape player. Should a transcriptionist hear an unfamiliar word, the standard practice is to stop the audio playback and look up the word in a printed dictionary.
Some medical transcriptionists may specialize in one area of medicine, or may deal primarily with a specific group of doctors. The level of familiarity with the doctors' voices and with the subject matter can increase the transcriptionist accuracy and efficiency over time.
The medical transcriptionist's time is less costly for the hospital than the doctor's time, and the medical transcriptionist is typically much more familiar with the computerized record-keeping systems than the doctor is, so this system offers a significant overall cost saving to the hospital.
To reduce costs further, health care organizations have deployed speech recognition technology, such as the AutoScript™ product (made by eScription™ of Needham, Mass.), to automatically transcribe medical dictations. Automatically transcribed medical records documents usually require editing by the transcriptionist. While speech recognition may accurately capture the literal word string spoken by the provider, the resulting document is generally not presented in a desired format.
Many new medical record documents could be or should be structured in tabular format with data values filled in to appropriate fields in the table. For example, laboratory reports, pathology reports, radiology reports and cardiac stress tests often can or should be wholly or partially formatted in tables with data filled in to the appropriate fields of the table.
In an exemplary scenario, a physician may dictate:                “patient's date of birth is January fifth, um let's see, ah, fifty three. Joe is a fifty one year old male who comes in today for a physical exam. On examination, his weight is one hundred eighty two pounds, BP is one twenty over eighty five. His general appearance is good.”        
It may be desired for the resulting portion of the document to appear as:
Sex: Male
DOB: Jan. 5, 1953
REASON FOR VISIT: Routine Physical.
PHYSICAL EXAMINATION:
General: Well-appearing
Pulse:
BP: 120/85
Weight: 182
Height:
At least one automatic speech recognition system currently exists for formatting dictated data into tabular form. This existing system is an interactive speech recognition system where the medical care provider sees the data table on the screen and, therefore, knows what data is expected to be dictated and in what order. The speaker using this system must verbally indicate that the speaker is moving to the next tabular field (for example, by saying “next blank”) before speaking the required data of the next field. Without interaction with the speaker, there is nothing to constrain the speaker to a particular sequence of dictating the desired information. Nor is there any way to guarantee that all required fields are available in the dictation when using the non-interactive system.